Cinnarizine as an alternative recommendation for migraine prophylaxis: a narrative review

ABSTRACT

Introduction

Despite the available prophylactic and acute drugs for migraine management, this disabling disorder remains undertreated especially among pediatrics. In this review, the authors aim at assessing the preventive role cinnarizine plays in treating migraine based on previously published studies.

Areas covered

Randomized clinical trials, randomized controlled trials, non-randomized open-label trials, and retrospective studies concerning cinnarizine in migraine prevention in children and adults were reviewed. Especial attention was given to the response rate, migraine characteristics, and tolerability.

Expert opinion

The majority of reviewed trials demonstrated that cinnarizine is comparable to the conventional drugs used in migraine prophylaxis. However, most of the reviewed studies were limited by a non-controlled open-label design. Due to poor planning and possibility of high placebo responses, particularly in children and adolescents, the interpretation of open-label studies’ results should be done cautiously. The evidence shows that cinnarizine’s effectiveness was more promising in pediatric migraineurs and adults with migraine-associated vertigo such as vestibular migraine. Therefore, while the efficacy of cinnarizine cannot be dismissed, before reaching a definite conclusion on its effectiveness, it is necessary to do further high-quality RCTs among both children and adults.

KEYWORDS:

• Adult migraineurs
• cinnarizine
• children migraineurs
• headache
• migraine
• prophylaxis

Article highlights

• Cinnarizine seems to be as effective and safe as other prophylactic drugs for migraine.

• The effective dose of cinnarizine for migraine prophylaxis is 75 mg/day in adults and 37.5-50 mg/day or 1.5 mg/kg/day in children.

• The quality of existing evidence regarding cinnarizine efficacy among adult migraineurs is relatively low.

• The efficacy of cinnarizine for migraine prophylaxis probably is more promising among pediatrics and migraine-associated vertigo.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Notes

1. SSRIs: serotonin reuptake inhibitors; TCAs: tricyclic antidepressants; CGRP: Calcitonin gene-related peptide; FDA: food and drug administration; AHS: American Headache Society; SV: sodium valproate; AAN: American academy of neurology; CIN: cinnarizine; SISC: Italian Society for the Study of Headache; RCT: Randomized clinical trials; IHS: international headache society; VAS: visual analog scale.

Additional information

Funding

This paper was not funded.